Surgical gut fulfills the requirements for the
perfect suture more often than any other material.
Manufacture of catgut: derived from
the submucosal connective tissue of the
first one-third (about 8 yards) of the
small intestine of healthy government
inspected sheep. The intestine of the
sheep has certain characteristics that
make it especially adaptable for surgical
use. It is of uniformly fine-grained
tissue structure and possesses great ten-
sile strength and elasticity.
Tensile strength of catgut: this suture
material is available in sizes of 6-0 to
0 and 1 to 4, with 6-0 being the smallest
diameter and 4 being the largest. The
tensile strength increases with the
diameter of the suture.
Kinds of surgical gut (catgut): this varies
from plain catgut, the raw gut that has
been gauzed, polished, sterilized, and
packaged, to chromic catgut that has
undergone various intensities of tanning
with one of the salts of chromic acid to
delay tissue absorption time. Some ex-
amples of these variations and absorp-
tion times are as follows:
(1) Type A: Plain, 10 days
(2) Type B: Mild chromic, 20 days
(3) Type C: Medium chromic, 30 days
(4) Type D: Extra chromic, 40 days
Suture needles may be straight or curved and
have either a tapered round point or a cutting edge
point. They vary in length, curvature, and
diameter for various types of suturing.
Sizing: suture needles are sized by diameter
and come in many sizes, depending on use.
Taper point: these cause small amounts of
tissue damage and are most often used in
Cutting edge point: this is the preferred
needle for suturing the skin because of the
toughness of the skin.
Atraumatic (atraloc, wedged): these needles
may either have a cutting edge or taper
point and have the suture fixed on the end
of the needle by the manufacturer to cause
the least tissue trauma.
Preparation of Casualty
Examine the casualty carefully to deter-
mine what materials are needed to properly
close the wound.
Select and prepare sterile instruments,
needles, and suture materials.
The patient should be securely posi-
tioned so that access to the wound and
suture tray is optimal. It is usually not
necessary to restrain patients for
Make sure a good light is available.
Aseptic wound preparation is to be strictly
observed. Use mask, cap, and gloves.
Thorough cleaning and proper draping is
Select an anesthetic with care. Consider the
patients tolerance to pain, time of injury,
medications the patient is taking or has
been given, and the possible distortion of
the tissue when the anesthetic is infiltrated.
The most common local anesthetic used is
Xylocaine, which comes in various strengths
(0.5%, 1%, 2%) and with or without epinephrine.
Injectable containing epinephrine are never to be
used on the fingers, toes, ears, or nose because
of the vasoconstricting effect of the epinephrine.
Epinephrine is also contraindicated in patients
with hypertension, diabetes, or heart disease. The
three methods of administration are topical, local
infiltration, and nerve block. Topical anesthetics
are generally reserved for ophthalmic or plastic
surgery and nerve blocks are generally ac-
complished by an anesthesiologist or anesthetist
for the surgical patient. For a corpsman, topical
anesthesia is limited to the instillation of eyedrops
for mild corneal abrasions after all foreign bodies
have been removed. DO NOT attempt to remove
embedded foreign bodies. Nerve blocks are
limited to digital blocks wherein the nerve trunks
that enervate the fingers or toes are anesthetized.
The most common method of anesthesia used by
a corpsman is the infiltration of the anesthetiz-
ing agent around a wound or minor surgical site.
Obtaining a digital block is a fairly simple pro-
cedure, but it should not be attempted except
under the supervision of a medical officer or after
a great deal of practice. The first step is cleans-
ing the injection site with an antiseptic solution.
The anesthetizing agent is then infiltrated into the
lateral and medial aspects at the base of the digit
with a small bore needle (25- or 26-gauge), tak-
ing care not to inject into the veins or arteries.